Provider Demographics
NPI:1326570391
Name:SNIDER, LAURA LESLIE (DDS)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LESLIE
Last Name:SNIDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:PURPLE BUILDING 5TH FLOOR
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-8513
Mailing Address - Fax:612-904-4297
Practice Address - Street 1:15616 EDGEWOOD DR STE 110
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56401-4492
Practice Address - Country:US
Practice Address - Phone:218-828-0565
Practice Address - Fax:218-828-0565
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice